PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Adult Care and Support for People Living with HIV/AIDS
NEED and COMPARATIVE ADVANTAGE: There are approximately 1.4 million people living with HIV/AIDS
(PLWHA) in Tanzania. The HIV prevalence is higher in urban areas (10.9%) than in rural areas (5.3%) and
varies per region. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) currently operates in the
regions of Kilimanjaro, Arusha, Tabora and Shinyanga. Within those regions, a cumulative total of 475,402
people are HIV-positive and in need of care and support, in addition to antiretroviral therapy (ART) services.
By the end of FY 2008, it was estimated that only 11.4% of PLWHA from these regions had accessed HIV
care and support. The percentage is expected to be much lower in the southern regions of Mtwara and
Lindi, where EGPAF will begin to extend support in FY 2009. EGPAF strives to provide optimum
accessibility to care and support services within all regions supported by the program.
ACCOMPLISHMENTS: As of the end of FY 2008, approximately 55,000 patients had been enrolled into HIV
care, approximately 40% of whom received Cotrimoxazole prophylaxis. The program trained 500 health
workers to provide comprehensive HIV care including patient monitoring. EGPAF has ensured a continuum
of care in the facilities through integration with prevention of mother-to-child transmission (PMTCT). To
improve the quality of services, EGPAF has provided infrastructure improvements as well as office,
laboratory, and pharmacy supplies and equipment. To strengthen care and support services, the program
has trained mentors at the district level to support primary health facilities.
ACTIVITIES: In FY 2009, EGPAF will strengthen the quality of care in the current supported regions by
supporting procurement of Cotrimoxazole prophylaxis to all sites and training pharmaceutical and logistics
management in all facilities. The program will ensure a continuum of care through linkages between care
and treatment, PMTCT and TB services, as well as community-based organizations (CBOs). All sites
supported with ART services will also offer PMTCT services. EGPAF will strengthen mechanisms for
referral of HIV-positive women from PMTCT to care and treatment by promoting the use of referrals,
physical escorting and patient registers. To ensure quality service within the PMTCT program, EGPAF will
train health care workers to carry out clinical staging of HIV-positive mothers and partners; HIV-positive
clients will be monitored at the Reproductive and Child Health (RCH) clinic and receive basic care services
until they are eligible for ART.
Clinical care will include prevention and treatment of opportunistic infections and other complications related
to HIV/AIDS. Pain and symptom management will be provided. There will be increased focus on
prevention with positives. PLWHA will be provided with information about ways they can protect their own
health, prevent common illnesses, and improve access to safe water and hygiene practices. EGPAF will
ensure that interventions address the comprehensive needs in an environment free from stigma and
discrimination. In support of this initiative, EGPAF will provide condoms and other contraceptives in facilities
where religion is not a constraint. PLWHA will be linked with sexually transmitted infection treatment
services and counseling to reduce high-risk behaviors. Counselors will discuss with PLWHA specific
strategies for disclosing one's HIV status to sexual partners, and offer confidential HIV testing to the
partners of and children born to all PLWHA in their coverage areas. EGPAF partners will link PLWHA with
programs that distribute insecticide-treated bed nets and promote their correct usage.
EGPAF will support community liaisons at each site to link enrolled patients to CBOs for supplementary
care and support. Groups of PLWHA will be supported to provide peer-led adherence counseling, track
clients who were lost to follow-up.
EGPAF will also support and expand provider-initiated testing and counseling to all health facilities, which
will include conducting community sensitization meetings to increase demand and uptake of testing. In the
newly-supported region of Lindi, the program will improve the care and treatment center (CTC)
infrastructure and provide other HIV care in response to regional and district needs.
In FY 2009, EGPAF will intensify its efforts in nutritional support for PLWHA. Specifically, EGPAF will
support CTCs to conduct anthropometric measurements and determine nutritional status using Body Mass
Index calculations and other appropriate measurements such has mid-upper arm circumference (MUAC)
and weight for age. EGPAF will procure the necessary equipment required to carry out effective nutritional
assessment such as weighing scales, MUAC tapes and stadiometers. The program will conduct training in
the use of these tools, as well as in dietary assessments of patients and the provision of nutrition counseling
and education. In addition, EGPAF will ensure the identification of clients eligible for the pilot therapeutic
supplemental feeding program, and will link with other organizations addressing household food security
and economic strengthening to ensure PLWHA have access to these services. Finally, the program will
provide counseling on how to maintain or improve nutritional status, prevent and manage food- and
waterborne illness, manage dietary complications related to HIV/AIDS and ART, and promote safe infant
and young child feeding practices.
LINKAGES: EGPAF will collaborate with the Council Multi Sectoral AIDS Committee to coordinate activities
in EGPAF-supported regions; assist Village Multisectoral AIDS Committees in community sensitization on
TB, HIV and male testing; and establish PLWHA support groups for psychosocial support, information
sharing and strengthening of follow up. The program will also collaborate with home-based care providers,
traditional birth attendants and healers, volunteers and PLWHA groups to strengthen participation in
antenatal care, voluntary counseling and testing, PMTCT and RCH services, as well as follow-up of HIV-
exposed patients. Finally, EGPAF will perform mapping of existing initiatives and collaborate with other
organizations to strengthen care of PLWHA (e.g., KIWAKKUKI, Mildmay, Makoye Resources and
Technologies Agency, the Tanzania Social Action Fund, and the World Food Programme).
New/Continuing Activity: Continuing Activity
Continuing Activity: 16353
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16353 16353.08 HHS/Centers for Elizabeth Glaser 6512 2369.08 $200,000
Disease Control & Pediatric AIDS
Prevention Foundation
Emphasis Areas
Health-related Wraparound Programs
* Malaria (PMI)
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $592,700
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP.
TITLE: Supporting ART services in six regions in Tanzania
NEED and COMPARATIVE ADVANTAGE:
There are approximately two million people living with HIV in Tanzania. The HIV prevalence is higher in
urban areas (10.9%) than in rural areas (5.3%) and it varies per region. In the Elizabeth Glazer Pediatric
AIDS Foundation's (EGPAF) current four regions, it is estimated that 100,823 people in Kilimanjaro, 68,527
in Arusha, 123,689 inTabora and 182,363 in Shinyanga are HIV infected and will need care and ART
services at some point. Only approximately 21% of the PLWHA who are in need of ART in these regions
were actually receiving this by the end of June, 2008. This percentage is expected to be even lower in
Mtwara and Lindi regions, where EGPAF will extend support in FY 2009. With a strong commitment and
support from the government and local authorities, EGPAF will play an important role to ensure optimum
accessibility to ART services.
ACCOMPLISHMENTS:
As of June 08, 24,897 patients have been initiated on ART in 78 health facilities, including 2,284 (9.1%)
children. The average increase of median CD4 was 39 after six months and 182 after one year. 555 health
workers have been trained to provide comprehensive ART care, including mentorship. In the past six
months, 40 new primary health facilities (PHC's) have started providing ART services. By the end of
September 2008, 60 more PHC's and two hospitals will be providing ART services in the four regions, for a
total of 140 facilities.
ACTIVITIES:
Strengthen ART services in the current EGPAF-supported health facilities, including primary health facilities.
Support planning, training, mentorship and supervision by district teams. Ensure HIV is included in
Comprehensive Council Health Plans. Improve referral systems between facilities, and facilitate transport
for mentorship, supervision and specimen testing. Conduct minor renovations and supply of equipment to
ensure uninterrupted services. Train back-up teams in hospitals and health centers on basic ART care.
Support activities for continuous quality improvement. Train mentors from the district and other higher level
facilities on ART care. Strengthen data collection, on-site utilization and reporting. In close collaboration
with the Clinton Foundation, expand support for ART services to underserved areas in Lindi and Mtwara
regions in response to a request by the Ministry of Health and Social Welfare (MOHSW).
Laboratory Activity:
Expand MOHSW zonal quality assurance (QA)\quality control (QC) activities. Work with regional and
facility-level Quality Assurance Officers to support zonal Quality Assurance Officers in conducting
supportive supervision of all regional and district CTCs in the zone.
Support implementation of the zonal external laboratory quality assurance activities by supporting the
quarterly meetings, and ensuring enrollment and participation of six regional labs in the national and
international external quality assurance (EQA) programs.
Support equipment services and maintenance by training 188 lab staff. Support zonal equipment engineers
to perform quarterly supervision, and produce quarterly updates on equipment status. They will report to
the Regional Medical Officers, EGPAF and equipment engineers at MOHSW diagnostic unit. Work with
Supply Chain Management Systems (SCMS) and the USG lab team to build the capacity of 188 CTC
laboratories' staff to plan in laboratory supplies and reagents forecasting and logistics to ensure
uninterrupted quality laboratory services. Procure reagents for hematology, chemistry and CD4 count.
Provide support for additional laboratory equipment (CD4, chemistry and hematology analyzer) for care and
treatment centers, when the needs are unmet by normal government supplies.
LINKAGES
EGPAF will: 1) collaborate with Council Multi Sectoral AIDS Committees (CMACs) to coordinate linkage
activities in EGPAF-supported regions; 2) assist Ward Multisectoral AIDS Committees (WMACs) in
community sensitization on TB, HIV, pregnant women and HIV, and male testing; 3) collaborate with HBC
providers, traditional birth attendants (TBAs), traditional healers, volunteers and PLWHA groups to
strengthen follow up of patients on ART.
CHECK BOXES
Activities related to renovation will be conducted in an effort to improve the capacity of health centers to
Provide care and treatment services. Human capacity development activities revolve around in-service
Training of health care workers. HIV testing and enrollment into treatment will focus on the general
Population
M&E:
EGPAF will collaborate with the National AIDS Control Program (NACP)/MOHSW to implement the national
M&E system for care and treatment in Arusha, Kilimanjaro, Shinyanga, Tabora, Mtwara and Lindi regions.
Data will be collected using paper-based systems, and where possible, entered into the National CTC2
database. District teams will be supported to perform M&E supportive supervisions to their respective sites.
EGPAF will provide the required national and PEPFAR reports. In order to promote a data use culture,
EGPAF shall provide regular feedback to supported sites and promote data utilization at sites through the
Quality Improvement program for better
Patient management. Data Quality Assurance: District teams will be supported to perform M&E supportive
supervision to their respective sites. Scale-up of electronic database: Currently, 15 facilities have the CTC2
database. This number will increase to 38 by September 2008. At the EGPAF Semi-annual partners
meetings, partners will share best practices, motivation and top performing sites will be recognized.
Operational practices will be standardized across all sites.
SUSTAINABILITY:
EGPAF Tanzania works closely with the Government of Tanzania (GOT) in the implementation of activities
Activity Narrative: to ensure that the plans are aligned with the national strategy. Local capacity building is ensured by
improving physical infrastructure, training and mentoring of local Tanzanian health workers and using local
Tanzanian technical officers in project implementation. Systems are developed that rely heavily on local
inputs and personnel. External technical assistance (TA) will gradually decrease over time. In the next
year, trainings from Baylor and The University of California San Francisco (UCSF) will
Concentrate on refresher trainings, training of trainers, and mentorships. District teams will be empowered
to do supportive supervisions and provide TA to lower-level facilities.
Continuing Activity: 13471
13471 3494.08 HHS/Centers for Elizabeth Glaser 6512 2369.08 $8,188,236
7706 3494.07 HHS/Centers for Elizabeth Glaser 4534 2369.07 Project HEART - $5,700,000
Disease Control & Pediatric AIDS Tz Budget
3494 3494.06 HHS/Centers for Elizabeth Glaser 2887 2369.06 Project HEART $1,700,000
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $593,610
Table 3.3.09:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Expanding Pediatric Care and Support Services in Six Regions
NEED and COMPARATIVE ADVANTAGE: There are approximately 140,000 children living with HIV in
Tanzania. By December 2007, fewer than 23,000 children less than 15 years of age had ever been
enrolled in care and treatment. The national care and treatment center (CTC) register does not report any
data concerning the percentage of children with severe malnutrition, but clinicians report high numbers, as
weight charts were introduced during FY 2008 at all sites supported by the Elizabeth Glaser Pediatric AIDS
Foundation (EGPAF).
ACCOMPLISHMENTS: By end of FY 2008, approximately 5,000 children were receiving care and
treatment, about 2,000 of whom were on antiretroviral therapy (ART). Of all children receiving care, over
3,000 (62%) were documented to be receiving Cotrimoxazole. EGPAF trained 70 reproductive and child
health (RCH) service providers on non-ART care and staging including re-identification of HIV-positive
mothers and their exposed children. A training course for lay counselors was developed, focusing on
children and their parents, and 48 lay counselors were trained. These lay counselors are involved in
service provision at testing and treatment sites, as well as in community sensitization and linkages to
community-based organizations. EGPAF trained 143 community and religious leaders on care and
treatment for HIV-positive children and their families. At the zonal hospital in Moshi and the regional
hospital in Arusha, malnourished patients are supported with either formula or ready-to-use therapeutic
food, which is supplied by UNICEF.
EGPAF took the lead in organizing and facilitating the First National Conference on Prevention, Care and
Treatment of HIV in Children in March 2008 in Dar es Salaam, and serves in the lead role on the Pediatric
AIDS Working Group under the National Care and Treatment Steering Committee.
ACTIVITIES: To implement a specific framework for pediatric HIV care, EGPAF will:
1. Improve identification, enrollment, and retention of HIV-positive and exposed children by training health
workers; implementing provider-initiated testing and counseling (PITC) at all contact points; implementing
early infant diagnosis (EID) using dried blood samples; strengthening linkages between prevention of
mother-to-child transmission and care and treatment so as to follow the exposed infant; and improving
infrastructure to provide child-friendly services.
2. Strengthen M&E for pediatric HIV care and treatment
3. Strengthen psychosocial support for HIV-infected and affected children
4. Strengthen government leadership and improve community involvement in scaling-up pediatric care and
treatment. The program will strengthen links to community support groups, especially for orphans and
vulnerable children (OVC). To ensure that children have access to insecticide-treated bed nets, the
program will link with malaria control programs in the area. For other essential pediatric care, EGPAF will
link with child survival programs offered through the Maternal Child Health (MCH) Clinics.
5. Intensify efforts in nutritional support for children living with HIV/AIDS. Specifically, EGPAF will support
CTCs to conduct anthropometric measurements and determine nutritional status using Body Mass Index
(BMI) calculations and other appropriate measurements such as mid-upper arm circumference (MUAC) and
weight for age. EGPAF will procure the necessary equipment required to carry out effective nutritional
supplemental feeding program, and refer patients with a BMI <18.5 to nutritional support and/or further
medical attention. Finally, EGPAF will promote safe infant and young child feeding practices and link with
other organizations addressing household food security and economic strengthening to ensure vulnerable
families have access to these services.
LINKAGES: To strengthen community linkages and follow-up, EGPAF will integrate lay counsellors into
service provision and promote regular team meetings between the various entry points in one institution
(e.g., outpatient departments, MCH clinics, TB clinic). With the rollout of PITC and EID, facilities will begin
to use new registers to allow improved patient tracking and follow-up. EGPAF will collaborate with home-
based care providers, traditional healers and birth attendants, volunteers and PLWHA groups to strengthen
participation in antenatal care, voluntary counselling and testing, prevention of mother-to-child transmission,
RCH services and follow-up of HIV-infected and exposed children. Finally, the program will map existing
initiatives and collaborate with other organizations to strengthen care of HIV-positive children and OVC,
such as KIWAKKUKI, Mildmay International, Makoye Resources and Technologies Agency, Pathfinder, the
Tanzania Social Action Fund, and the World Food Programme.
M&E: EGPAF will continue to collaborate with the National AIDS Control Programme (NACP) and MOHSW
to implement the national M&E system for care and treatment in the facilities where EGPAF provides
technical assistance. Eforts will continue to focus on transitioning from using the national paper-based tools
to electronic versions in all CTCs. The program will provide funds for each, initiating the CTC to purchase a
computer that will be used to store patient monitoring data. Quality of data will be assured through
supportive supervision by EGPAF regional M&E officers working in collaboration with trained Council and
Regional Health Management Teams (CHMT and RHMT) members, where possible.
EGPAF will continue to collect reports from sites to be submitted to the NACP as requested by the
MOHSW. EGPAF will also continue to share regional data reports with Regional AIDS Coordinators.
EGPAF will work with CTCs to assist with generation of simple data reports for use by the sites in planning
(e.g., to improve appointment scheduling and drug forecasting) and for feedback and quality improvement.
Currently, all initiating CTCs are using the national Microsoft Access-based CTC2 database.
SUSTAINABILITY: EGPAF is committed to sustainability and plans to continue to work through local
authorities to create ownership, putting the responsibility of sustainability into their hands. Training and
mentoring of CTC staff, RHMTs, and CHMTs to build technical and management capacity, and continuing
Activity Narrative: to use national standards and guidelines also helps ensure sustainability. EGPAF will participate in the
GOT budgeting and planning cycles at district and regional levels to ensure integration of all programs.
Geographic Coverage Areas: (Regions) Arusha, Kilimanjaro, Tabora, Shinyanga, Lindi, Mtwara
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $15,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Table 3.3.10:
THIS IS A NEW ACTIVITY.
TITLE: Expanding Pediatric ART services in six regions
NEED AND COMPARATIVE ADVANTAGE
There are approximately 140,000 children living with HIV in Tanzania. By the end of 2007, only 11,176 had
ever received ART. The need and gaps for ART in children is similar in the EGPAF-supported regions of
Kilimanjaro, Arusha, Tabora and Shinyanga, as in other parts of the country.
ACCOMPLISHMENTS
By end of June 2008, 4,972 HIV-infected children were receiving care and treatment. Of those, 1,924 were
on ART, representing 9.2% of all patients on ART. Of the children on ART, 10% are under two years of age;
22.6% are of two to four years of age. Sixty service providers were trained on comprehensive pediatric
ART, while another 107 had refresher training on pediatric ART.
EGPAF played a central role in the opening of the Child Centered Family Care Clinic (CCFCC) at
Kilimanjaro Christian Medical Center (KCMC) in December 2007. The CCFCC focuses on care and
treatment for HIV-infected children and their families. The center currently cares for 36 families with three or
more infected members, and for 128 families with two infected members. 328 HIV-exposed children had
early infant diagnosis (EID), of whom 11.2% were HIV infected. Currently, 363 HIV-infected children receive
care, and 240 receive ART (5% are less than two years old). The Continuous Pediatric Education Program
at the center provides expert services as a pediatric HIV outreach program for all hospitals in the
Kilimanjaro region. The Centre provided various hospitals in other regions with mentoring by a specialist
who was paired with clinicians from the CCFCC. It also supported the pediatric warm-line, a telephone and
email service for problem-solving at a distance. This is promoted to clinicians caring for children living with
HIV/AIDS CLWHA throughout Tanzania. The introduction of a teen-club that started at the CCFCC has
been initiated in seven other sites. 143 community/religious leaders were sensitized on partner-initiated
counseling and testing (PITC) and pediatric care and treatment. Most sites have introduced a register for
HIV-exposed children to guarantee the provision of prophylaxis, as well as early identification of infected
infants and young children. EGPAF fully participated in the national role out of dried blood spot (DBS)
polymerase chain reaction (PCR) (see lab narrative).
ACTIVITIES
EGPAF shall implement a specific framework for pediatric HIV care, which has the following activities.
To improve identification, enrolment and retention of HIV-infected children on ART, EGPAF will train
regional and district trainers and mentors. They will then, in turn, train and mentor service providers at all
supported facilities in PITC and comprehensive care for HIV-infected and exposed children. Some PLWHA
will also be trained as lay counselors. Wherever possible, retired officers will be recruited to support the
testing of all children with unknown HIV status and their access to facility services. EGPAF shall supplement
test kit supplies for children and their families. EID using DBS PCR will be scaled up to all 36 hospitals and
52 primary health care facilities providing care and treatment services. To accomplish this, EGPAF will train
more trainers who will then train as many facility staff as possible in specimen collection and establishing
and facilitating transportation of specimen and results. This will enable testing of all HIV-exposed children
from any point of contact. To strengthen linkages between PMTCT and care and treatment, EGPAF will
facilitate regular review meetings at the district and facility level, and train service providers in the
reproductive and child health units (RCH) on care and treatment. Service providers will also be trained on
stock keeping and drug and reagent forecasting to ensure consistent availability of drugs and laboratory
supplies. In addition, facilities will be improved to provide adequate and attractive space for children's care.
To institutionalize child friendly services, facilities will be encouraged to establish child-specific clinic days
and guided on how to set up child-friendly services.
EGPAF will also facilitate sensitization activities for community leaders on pediatric ART. They will facilitate
message production and dissemination for local media and drama, and form partnerships with local
community-based organizations (CBOs) for greater community involvement and participation.
To improve retention of HIV-infected children on ART, EGPAF will strengthen nutrition and psychosocial
support for children on ART. EGPAF will identify, and forming partnerships with other organizations that
offer nutritional and psychosocial support. EGPAF will also support development and/or dissemination of
information, education and communication (IEC) materials specifically for HIV-infected child nutrition in
order to increase community knowledge and practices on feeding HIV-infected and exposed children.
Health facility service providers will be trained and mentored on providing psychosocial support to HIV-
infected children and their families/caregivers. EGPAF will use the experience of its Ugandan program to
facilitate the formation of family and PLWHA support groups to support psychosocial care for children.
See Pediatric Care narrative for complete package of services for pediatric patients on ART.
For broader national scale up of pediatric ART, EGPAF will support the Ministry of Health and Social
Welfare's (MOHSW) capacity to coordinate pediatric-specific HIV care and treatment by facilitating: national
meetings, the Pediatric Technical Working group, study visits by national leaders, and development of a
pediatric-specific national plan for treatment and care of HIV-infected children. In addition, EGPAF will
continue to coordinate the epidemic-HIV integration demonstration project that is being implemented by
EGPAF, Harvard, Columbia University and AIDS Relief.
EGPAF will: 1) collaborate with Council Multi Sectoral AIDS Committees (CMACs) to coordinate pediatric
HIV care activities in EGPAF-supported regions, 2) assist Ward Multisectoral AIDS Committees (WMACs) in
community sensitization on pediatric HIV care, 3) establish PLWA support groups for psychosocial support,
information sharing and strengthening of follow up, 4) collaborate with HBC providers, traditional birth
Activity Narrative: attendants (TBAs), traditional healers, volunteers and PLWHA groups to strengthen participation in
antenatal clinics, VCT, PMTCT and RCH services, and follow up of HIV-exposed/infected persons, 5)
perform mapping of existing initiatives, and collaborate with other organizations to strengthen care of HIV-
infected and exposed children (e.g. KIWAKKUKI, MILDMAY, MARTEA, TASAF, WFP).
MONITORING AND EVALUATION
EGPAF will build the capacity of facilities, districts, and regional health authorities in data collection,
interpretation, and reporting. To do this, EGPAF will by distribute patient enrolment tally sheets and
registers, train staff on the use of data collection tools and data quality improvement, and facilitate
supervision and mentoring visits. EGPAF will facilitate information flow from facility to district to regional
and to national levels. District teams will be supported to perform M&E supportive supervision to their
respective sites. EGPAF will provide the required national and PEPFAR reports. In order to promote a data
use culture, EGPAF shall provide regular feedback to supported sites, and promote data utilization at sites
through the quality improvement program for better patient management. At the EGPAF semi-annual
partners meetings, partners will share best practices and operational practices standardized across all sites.
SUSTAINABILITY
EGPAF Tanzania works closely with the Government of Tanzania in the implementation of activities to
ensure that the plans are aligned with the national strategy. Local capacity building is ensured by improving
physical infrastructure, training and mentoring of local Tanzanian health workers and using local Tanzanian
technical officers in project implementation. Systems are developed that rely heavily on local inputs and
personnel. External technical assistance (TA) will gradually decrease over time In the next year, training
from Baylor and the University of California San Francisco (UCSF) will concentrate on refresher training,
training of trainers, and mentorship. District teams will be empowered to do supportive supervision and
provide TA to lower level facilities.
Estimated amount of funding that is planned for Human Capacity Development $200,050
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Scale up of TB /HIV services in Care and Treatment Clinics in four Regions
This is an ongoing activity. In FY09 EGPAF will continue providing support to all sites implementing TB/HIV
collaborative activities. The priority focus for FY09 is the implementation of the "three Is" which will
strengthen Intensified TB case Finding (ICF), implementation of TB Infection Control (IC) and Isoniazid
preventive therapy (IPT). EGPAF will provide support to the health facilities to make sure that all HIV
infected patients attending HIV care and treatment are screened for TB using national TB screening tools.
Patients who are suspected of having active TB will be investigated as per National TB and Leprosy
guidelines. Patients found to have active TB will be immediately referred to the TB clinic to initiate
uninterrupted treatment using the Directly Observed Therapy (DOT) method. Patients tracking and follow up
system from Care and Treatment Clinic (CTC), laboratory and TB clinic will be strengthened. EGPAF will
work with NTLP and NACP in supporting the activity of piloting provision of IPT. All guidelines for
implementation of TB/HIV collaborative activities will be printed and distributed to all implementing health
facilities. TB infection control practices will be implemented in the care and treatment clinics to prevent
transmission of TB among PLWHA as well as health care providers. Health care providers from CTCs will
be trained on TB/HIV co-management, TB infection control, intensified case finding, recording and
reporting. EGPAF will strengthen existing laboratory services including improved sputum smear microscopy
and supplement supply of X-ray films. Outreach ART services to remote TB clinics in the regions will be
supported.
NEED and COMPARATIVE ADVANTAGE: Tanzania ranks 14th among the 22 highly burdened countries
with increased HIV/AIDS epidemic. According to the National Tuberculosis and Leprosy Program (NTLP),
TB -HIV dual infection contributes to 17.5 % of the total disease burden in Tanzania. Most health workers
have trouble finding up-to-date information with regard to TB control and don't intensify TB screening
among HIV patients. The TB/HIV activities have the objectives of creating the mechanism of collaboration
between tuberculosis and HIV/AIDS departments, reducing the burden of tuberculosis among PLWHA and
reducing the burden of HIV among TB patients, leading to more effective control of TB among HIV-infected
people.
ACCOMPLISHMENTS: From October 2006 to end of March 2007, all our supported sites monitored HIV
patients who where infected with TB. A total of 370 patients received TB treatment during that period. The
clinicians at the EGPAF supported sites use the clinical forms which have TB screening questions thus
ensuring the screening of all the patients. Linkage meetings between the TB and HIV clinics staff have been
promoted. Patients were referred from care and treatment clinics to TB clinics and vise versa using referral
forms.
ACTIVITIES: 1) All HIV infected patients receiving HIV care and treatment will be screened for TB routinely
and those suspected will access TB diagnostic services. Those found positive for TB will be immediately
referred to the TB clinic to initiate uninterrupted treatment using the Directly Observed Therapy (DOT)
method 1a) Support creating clinical forms with TB screening tool. 1b) Clinicians at each site will be trained
on TB/HIV collaborative activities including use of modified clinical forms to routinely identify underlying TB
signs and symptoms for all clients attending Counseling and Testing Centers (CTC). 1c) Develop a referral
system for access of HIV-infected TB suspects to laboratory diagnosis and treatment for TB.
2) TB infection control practices will be implemented in the care and treatment clinics to prevent
transmission of TB among PLWHA as well as health providers. 2a) CTC staff at each site will be trained on
TB infection control practices, and ensure ventilation in care and treatment clinics.
3) Strengthen existing laboratory services needed to implement TB/HIV program activities. 3a) Supplement
supply of X-ray films.
4) Support outreach ART services to remote TB clinic in the regions.
LINKAGES: With the new funding EGPAF will collaborate with the National TB and Leprosy Program
(NTLP) to increase more linkages between all the care and treatment sites and TB clinics. Referrals will be
strengthened by modifying current registers and ensuring all information regarding referral is accurately
recorded and reported. All the patients who are diagnosed to have TB at HIV care clinics will be referred
using referral forms to TB clinics and start anti-TB treatment promptly. Linkages with the community and
community based organizations (CBOs) will also be strengthened through regular meetings to reach TB
patients who should be screened for HIV.
CHECK BOXES: The areas of emphasis and target population have been selected following the planned
activities so that all male and female patients attending the CTC are adequately screened and treated for
TB, and TB prevention procedures at the CTC are strengthened.
M&E: EGPAF will collaborate with NTLP and The National AIDS Control Program (NACP) for the TB/HIV
M&E system for data collection and reporting. This will include the incorporation of the TB screening
questions into the clinical recording form, the modification of the TB clinic and the CTC registers to include
TB data. Referral of patients between the TB clinic and CTC will be done by a written referral form with a
detachable slip for returning to the referring unit. The site linkages person will be responsible for tracking
referrals between the CTC and other facility units including the TB clinic. TB/HIV data will be entered into
same CTC data by the site data entry clerk. Training, development of standard operating procedures
(SOPs) and supportive supervision will strengthen the quality and use of data. Data from primary health
facilities with both CTC and TB/HIV activities will be collected and reported by a designated site coordinator,
just like at the current CTC sites.
SUSTAINAIBLITY: EGPAF will support the Regional TB and Leprosy Coordinator in each region to initiate
Activity Narrative: and coordinate TB/HIV activities in each district hospital and health centre that has both a TB clinic and a
CTC. Within district and district designated hospitals EGPAF will assist in building linkages between the TB
and HIV clinics through a Multi Disciplinary Team approach. Management and contact persons in the CTC
and the TB clinics will be supported to plan for implementing an integrated program.
Continuing Activity: 13470
13470 12462.08 HHS/Centers for Elizabeth Glaser 6512 2369.08 $300,000
12462 12462.07 HHS/Centers for Elizabeth Glaser 4534 2369.07 Project HEART - $300,000
Table 3.3.12:
Need and comparative advantage: Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a Track 1.0
ART partner working in Kilimanjaro and Arusha regions in the Northern Zone, and in Tabora and
Shinyanga regions of the Lake Zone. Kilimanjaro Christian Medical Centre (KCMC) laboratory is a referral
center for six regions, Kilimanjaro, Tanga, Arusha, Manyara, Dodoma and Singida. . EGPAF has been
supporting KCMC laboratory with procurement of reagents. EGPAF has also supported Voluntary
Counseling and Testing (VCT) and PMTCT activities and has the capacity to provide technical support and
material inputs necessary to assist KCMC laboratory to implement quality system EGPAF has teams
working closely with Regional Health Management Teams and Council Health Management Teams
(RHMTs and CHMTs), faith and community-based groups and Ministry of Health and Social Welfare. KCMC
Laboratory is a referral laboratory for HIV diagnostic, and ART monitoring testing, tuberculosis and for early
infant diagnosis services. The KCMC laboratory began quality systems implementation in 2005. In 2008 the
Ministry of Health and Social Welfare (MOHSW) decided to prepare the five referral hospital laboratories for
international accreditation. As part of this process, with USG support the Clinical and Laboratory Standards
institute (CLSI) conducted an assessment of these hospital laboratories using ISO 15189 and Tanzanian
Health laboratory Standards documents. A gap analysis reported was presented to the participating
laboratories and the MOHSW. In 2007 and 2008 CLSI placed experienced laboratory mentors in these labs
for short periods of time to guide the laboratories on accreditation. EGPAF will use FY 2009 funding to
address the gaps identified during the gap analysis.
Accomplishments: New partner
.Activities The purpose of this funding is to implement laboratory Quality Management Systems (QS) at
KCMC referral laboratory for it to support the Northern Zone regional laboratories and to attain international
accreditation. EGPAF will assist KCMC laboratory establish and strengthen internal and external quality
assessment schemes in collaboration with the National Health Laboratory Quality Assurance and Training
Center. These will initially focus on HIV diagnosis, treatment monitoring and opportunistic infection
diagnostic tests. EGPAF will conduct hospital wide training for laboratory and non laboratory staff on
specimen management, including specimen collection, transportation, safety and post exposure
prophylaxis.
In COP 09 EGPAF will train 20 laboratory personnel on equipment preventive maintenance thereby reduce
laboratory service down time. EGPAF in collaboration with MOHSW and USG laboratory partners will
implement and maintain MOHSW standardized laboratory management documents, such as laboratory
registers, request forms, temperature charts, equipment monitoring logs, analytical charts, and Standard
Operational Procedures. As part of QS implementation, KCMC will have in place a documented process to
validate all laboratory process from pre-analytical, analytical, and post analytical phases and will train all
laboratory personnel on good laboratory practices (GLP).
KCMC will continuously improve and monitor the improvement of the laboratory services and customer
satisfaction by meeting with laboratory and clinical staff on a regular basis.
Linkages: EGPAF link with MOHSW, AMREF and other USG laboratory Implementing partners like CLSI,
working on the laboratory standards and zonal labs accreditation, ASCP training of in-service for laboratory
standard of care tests like CD4, Chemistry and hematology, APHL assisting with lab information system;
AIHA a twinning organization which has arranged partnership between regional hospital laboratories and
Boulder Colorado Community hospital in US. EGPAF will liaise with the ART services in KCMC, the
National TB Reference Laboratory, MOHSW Diagnostic Services Section, AMREF, and Columbia
University.
M&E: Monitoring forms for HIV/AIDS services at KCMC currently do not have a representative laboratory
component. EGPAF will collaborate with MOHSW CDC and CLSI to develop quality indicators to guide and
monitor implementation of the quality system utilizing the checklist developed by MOHSW.
Sustainability: The KCMC management was involved at the inception of the accreditation process and are
supportive of the activity. All of the activities are implemented by KCMC personnel with financial and
technical assistance from EGPAF, CDC Tanzania and USG laboratory partners. The staff meetings
between the hospital management, clinicians and laboratory personnel as part of customer satisfaction and
continuous improvement will promote laboratory integration in the day to day hospital management
activities and thereby sustain the quality initiatives,. Management support is crucial to the success of quality
systems implementation. . .
Targets: (Select program area targets and delete the remaining targets)
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.16:
